Colonic irrigation for defecation disorders after

Authors: Sacha M Koch Özenç Uludağ Kadri El Naggar Wim G van Gemert Cor G Baeten

Publish Date: 2007/09/21

Volume: 23, Issue: 2, Pages: 195-200

PDF Link

Abstract

Dynamic graciloplasty DGP improves anal continence and quality of life for most patients However in some patients DGP fails and fecal incontinence is unsolved or only partially improved Constipation is also a significant problem after DGP occurring in 13–90 Colonic irrigation can be considered as an additional or salvage treatment for defecation disorders after unsuccessful or partially successful DGP In this study the effectiveness of colonic irrigation for the treatment of persistent fecal incontinence and/or constipation after DGP is investigatedPatients with defecation disorders after DGP visiting the outpatient clinic of the University Hospital Maastricht were selected for colonic irrigation as additional therapy or salvage therapy in the period between January 1999 and June 2003 The Biotrol® Irrimatic pump or the irrigation bag was used for colonic irrigation Relevant physical and medical history was collected The patients were asked to fill out a detailed questionnaire about colonic irrigationFortysix patients were included in the study with a mean age of 593 ± 124 years 80 female On average the patients started the irrigation 2139 ± 3877 months after the DGP Eight patients started irrigation before the DGP Fiftytwo percent of the patients used the irrigation as additional therapy for fecal incontinence 24 for constipation and 24 for both Irrigation was usually performed in the morning The mean frequency of irrigation was 090 ± 040 times per day The mean amount of water used for the irrigation was 227 ± 175 l with a mean duration of 39 ± 23 min Four patients performed antegrade irrigation through a colostomy or appendicostomy with good results Overall 81 of the patients were satisfied with the irrigation Thirtyseven percent of the patients with fecal incontinence reached pseudocontinence and in 30 of the patients the constipation completely resolved Side effects of the irrigation were reported in 61 of the patients leakage of water after irrigation abdominal cramps and distended abdomen Seven 16 patients stopped the rectal irrigationDynamic graciloplasty DGP is a proven effective treatment for fecal incontinence Success rates vary from 42–92 1 2 3 4 5 Comparison of results is difficult because the outcome of this method seems to be influenced by the etiology of fecal incontinence preexisting stoma length of followup method of stimulation and the surgeon’s experience 1 6 DGP significantly improves quality of life and anal continence for most patients 2 Quality of life and patient satisfaction scores correlate significantly with continence scores 7 8 However in some patients fecal incontinence is unsolved or only partially improved after DGPMorbidity rates are high after DGP complications associated with the technique can often be prevented or treated but other complications like reduced sensitivity of the rectum by destruction of sensory nerves can be very hard to treat and often result in DGP failure 4 8 9 Morbidity rates are lower and success rates higher in the hands of surgeons experienced in the technique 3 10Constipation is a significant problem after graciloplasty occurring in 13–90 of the patients after DGP 6 7 8 11 12 Constipation due to technical failure like a gracilis wrap that is too tight can be treated by revisional surgery Other causes of constipation can first be treated with dietary measures and medication In case of pelvic floor dysfunction biofeedback training can be started 9 When this first line treatment is unsuccessful retrograde colonic irrigation can be considered Colonic irrigation can also be used as an additional therapy or salvage therapy for persistent fecal incontinence after failed or partially failed surgery 13 Not much is known about the success rate of retrograde colonic irrigation as there is only a limited number of published studies 13 14

Keywords: